Development and pilot evaluation of a web-based psychoeducation program for people with pathological dissociation

Abstract

Pathological dissociation is a common trauma-related mental health problem that is associated with considerable healthcare and social service needs. People with pathological dissociation typically require psychosocial interventions. However, challenges in providing psychosocial interventions for people with pathological dissociation exist in the field (e.g., dissociation-focused psychotherapy is expensive, is not available in many places, and may be further limited during pandemics). It has been well documented that there are advantages to using online methods to enhance healthcare and social services (e.g., high accessibility and low cost) and that web-based interventions are helpful for people with other mental health problems (e.g., depression, anxiety, and post-traumatic stress disorder). An important question that remains unexplored is whether web-based interventions are acceptable and beneficial to people with pathological dissociation. At the time of initiating this project, no study had evaluated any kind of web-based intervention for this specific population. This project aimed to evaluate the use of web-based psychoeducation to support people with pathological dissociation. A specific trauma-informed, dissociation-focused, web-based psychoeducation program was developed. It was predicted that after this brief educational program, participants would have improvements in recovery (in terms of symptom management), self-esteem, mental health stigma, and comorbid symptoms, while their dissociative symptoms would remain stable, and that most participants (at least 60%) would be satisfied with the web-based program. A pilot evaluation study was conducted to (1) examine the acceptability, (2) explore the potential benefits, and (3) identify the perceived limitations of the program. The findings revealed that most participants were satisfied with the web-based program (e.g., most participants agreed that the program helped them understand [94.1%] and manage [66.7%] their mental health conditions and remain hopeful for recovery [78.4%]), that the dropout rate was acceptable (36.25%), and that participants had statistically significant improvements in symptom management (p < .001, Cohen's d = -0.561) and self-esteem (p = .008, Cohen's d = -0.387) after completing the program. Female participants (92.16% of the entire sample) also had statistically significant improvements in mental health stigma (p = .029, Cohen's d = 0.328) after completion of the program. Further analysis demonstrated that symptom management, self-esteem, and mental health stigma remained unchanged during the double pretest control period and the follow-up period, and that these variables improved only after the program. In the qualitative feedback, participants generally acknowledged that the program could help them better understand and manage their mental health conditions; some participants also appreciated the advantages of using online methods (e.g., overcoming time and geographical limits, no face-to-face pressure). This is one of the first projects to evaluate web-based interventions for people with pathological dissociation. The findings showed that the web-based program can be readily used to provide educational support for this vulnerable service group because of its high acceptability, potential benefits, and low cost. However, further evaluation of the program is necessary. Some directions for further development of the program are discussed. Implications for the use of information and communication technology (ICT) to improve mental health services are also highlighted. This study demonstrates that ICT can be used to support different aspects of mental health services, such as engagement, assessment, service delivery, and evaluation, which would be especially important in the post-COVID-19 era.